Social networking: Personal boundaries

Mobile phone showing social media apps on screen, next to wired headphones.

As a growing number of social interactions move online, boundaries can sometimes become blurred when it comes to appropriate conduct, especially on electronic platforms. While guidelines are already in place for the treatment of family in clinical settings, how do those rules apply to other social relationships, or online relationships? Not knowing where to draw the line may result in a patient feeling confused or mistreated, and making a complaint. 

We take a look at the medical practitioner Code of Conduct, and see what is already in place to help guide social engagement for medical practitioners online. 

What are the guidelines around social media usage for medical practitioners?
Social media and online platforms can be incredibly useful in our professional and personal lives, helping us communicate quickly and effectively, outsource tasks and labour, or build communities and connections. However, digital platforms have inbuilt limitations which can blur professional boundaries and change doctor-patient dynamics. Professional interactions can inadvertently occur with an online contact, and any subsequent inappropriate behaviour can lead to a breach in professional standards, and a complaint being made against the practitioner.

The Medical Council of NSW has received complaints regarding doctors who may have initially inadvertently treated people they have met online, then continued personal relationships with these patients, despite being aware of the doctor-patient relationship. In one case, a patient’s treating psychiatrist made a mandatory notification to the Medical Council, and the doctor referred to in the notification was cautioned for a breach in professional conduct.

Navigating appropriate conduct when it comes to treating someone who you may have chatted with on Instagram, Facebook, or a dating app but never met in person can be confusing, and it is a relatively new area for regulators too. We refer to the Medical Board of Australia’s guidelines to help understand the official advice, and how this can help prevent a complaint been made about you.

What are the rules when it comes to treating someone you may have previously met online?
Medical practitioners and students have an ethical and legal duty to maintain professional boundaries with patients. These boundaries remain the same whether communicating in-person, via social media, text or other means of communication.

The Good medical practice: a code of conduct for doctors in Australia makes clear it is not appropriate for a doctor to engage in sexual activity with a patient, regardless of the patient’s behaviour. It is the doctor’s responsibility to re-establish professional boundaries or end the therapeutic relationship and transfer care to another doctor. Adequate safety netting needs to be in place to ensure appropriate transfer of care occurs, and the doctor should note any decisions regarding the therapeutic relationship in the patient’s medical record.

While it is allowable to treat family members or other close relationships in an emergency only, the Medical Board of Australia and the Medical Council both reinforce the importance of avoiding this where possible to avoid clouded judgement due to personal involvement and concerns about an appropriate level of care, documentation and communication. In particular, doctors should not prescribe Schedule 8, psychotropic medication and/or drugs of dependence or perform elective surgery to anyone with whom they have a close personal relationship.

What are the guidelines when it comes to relationships with former patients?
According to the MBA guidelines, a doctor must recognise the influence they have had on patients and that a power imbalance could continue long after the professional relationship has ended. The doctor should consider carefully whether they could be exploiting the trust, knowledge and dependence that developed during the doctor-patient relationship before they decide whether to engage in a relationship with a former patient. Important factors to consider include:

  • the duration, frequency and type of care provided by the doctor; for example, if they had provided long-term emotional or psychological treatment;
  • the degree of vulnerability of the patient;
  • the extent of the patient’s dependence in the doctor-patient relationship;
  • the time elapsed since the end of the professional relationship;
  • the manner in which, and reason why, the professional relationship ended or was terminated;
  • the context in which the sexual relationship started.

What is best practice when it comes to conduct online or on social media?
It is best for doctors to err on the side of caution when it comes to communicating informally with patients online, or posting to social media profiles. While it is possible to maintain separate personal and professional accounts, these can sometimes overlap, and doctors need to be aware of the potential risks of posting from even a private profile, or engaging with patients online. Improper online conduct can undermine professional integrity and public trust, as well as lead to patient harm.

The Medical Council expects doctors to maintain professional boundaries when using social media and other digital platforms to communicate with patients. If a patient tries to engage with a doctor through social media or other digital platforms about matters outside the professional relationship, the doctor should decline to interact with them and direct them instead to the doctor’s usual professional healthcare communication channels.

Medical Board of Australia - Sexual boundaries in the doctor-patient relationship